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Are you facing challenges in providing geriatric care for your parents? This educational video offers solutions and insights into the complexities of caring for geriatric care parents.
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0:01
hello everybody this is Dr arish sharuk
0:03
I'm a geriatrician and oncologist with
0:05
more than 12 years of experience of
0:08
taking care of older adults with or
0:09
without cancer my area of expertise and
0:13
interest is improving outcomes and Care
0:15
process for older adults regardless of
0:19
whether they have cancer or not one step
0:22
in achieving that is to empower and
0:25
inform patients and caregivers
0:27
especially when it comes to aging
0:28
related issues
0:30
so with that the title of this talk is
0:33
what you should know about geriatric
0:35
care and why it
0:37
matters so in this lecture we are going
0:40
to understand what Frailty is we are
0:42
going to become more familiar with
0:44
Frailty assessments and we are going to
0:47
appreciate the benefits that
0:48
collaboration between geriatricians and
0:50
other disciplines bring for older
0:53
patients and their
0:55
caregivers so let's start with a case
0:58
this case is very familiar to many of
1:00
you regardless of the diagnosis or any
1:03
other characteristic of this case this
1:05
is the Curious Case of Mr P so Mr P is a
1:08
82y old male who was admitted to the
1:10
hospital with shortness of bread this
1:12
was his third hospital visit with the
1:15
same complaint in just two months
1:18
diagnostic workup shows that his chess
1:20
cray is showing some fluid in the long
1:23
Echo confirms weaken heart with ejection
1:26
fraction of just 30% the normal is more
1:29
than 50 50
1:31
55% and the medical team correctly
1:33
diagnosed this patient with acute heart
1:35
failure basically heart notot pumping
1:38
the blood as much as it should causing
1:40
some back flow fluid in the lungs and in
1:43
the legs so the treatment that the
1:45
medical team has planned for was to
1:47
administer fide which is a medication to
1:50
increase urination and not surprisingly
1:53
Mr P experienced a symptomatic
1:55
Improvement within 24 hours of that
1:58
treatment
2:01
however the next day the medical team
2:03
receives a frantic call from a concerned
2:05
daughter the daughter mentions that my
2:07
father has fallen multiple times in the
2:09
past few months it may not be safe for
2:11
him to go home my father is probably not
2:14
taking his medications properly as I
2:16
have found his medication bottles
2:18
beneath the couch my father's appetite
2:21
has also been poor and he has lost some
2:23
weight you may not have noticed it
2:25
because he was very swollen I'm also
2:27
very worried about his cognition at
2:29
times I feel he's not as sharp as he was
2:32
before this story is very similar to
2:36
many stories that we hear and we
2:39
encounter for our older parents older
2:41
grandparents older family members when
2:44
they are in the hospital and the the
2:47
medical team focuses on the main
2:49
presenting symptom and the main
2:51
diagnosis but the question is what the
2:54
medical team should have done and what
2:55
was
2:58
missing so the question for you would be
3:03
what do you see in this page I will give
3:05
you five seconds to think about
3:11
it so I'm sure a lot of you have
3:15
mentioned that what you're seeing is
3:17
either a circle or a DOT and that is
3:20
true that Circle or a DOT is heart
3:22
failure this patient main diagnosis was
3:25
heart failure but was there anything
3:28
else that we needed to see let's take a
3:30
look a little bit deeper and you see
3:33
some smaller dots that in the first sort
3:36
of assessment was not visible to many
3:38
care providers so what are these smaller
3:42
dots these smaller dots are diseases and
3:46
issues like dementia poly Pharmacy
3:49
taking too many medications poor
3:51
nutrition exhausted caregiver many
3:54
hospitalization gate and balance
3:56
impairments and
3:57
Falls so the
4:00
medical team may say well this patient
4:02
presented resurance of breath and he was
4:04
diagnosed with heart failure we properly
4:06
treated heart failure why we should be
4:09
bothered by the rest of these issues
4:12
well the challenge is that the rest of
4:13
these issues whether we like it or not
4:16
are somehow either impacting the main
4:19
diagnosis or impacting the outcome of
4:22
that main diagnosis or they are
4:24
contributing to some of the issues in
4:26
the future so for example if a patient
4:29
is is taking too many medication meaning
4:31
that the patient is experiencing bully
4:33
Pharmacy and now because of the heart
4:35
failure this patient is going to be
4:37
taking couple more medications the risk
4:39
of non-compliance in this patient is
4:41
quite high and this patient may not take
4:43
his medications properly and may come
4:45
back to the hospital or if the patient
4:48
takes his medications properly but has
4:50
been suffering from gate and balance
4:52
impairment because of lightheadedness
4:53
and dizziness because of the drop in the
4:56
blood pressure this patient may fall and
4:58
experience a hip fracture and need
5:00
another hospitalization and surgery or
5:04
if the caregiver is already exhausted
5:06
there's no way that that caregiver can
5:08
provide hard healthy meal for these
5:10
patients you know the low sodium diet
5:12
that many cardiologists and heart
5:15
doctors advis for these sort of
5:18
patients but even if we see these
5:21
smaller dots we still may have Miss the
5:24
white page or the white Slide the white
5:27
background so what is that white page or
5:30
white
5:31
background that is the whole patient
5:34
that is Mr
5:36
P throughout this whole process we have
5:39
missed Mr P as a whole we focus on some
5:43
diseases We Shrunk Mr P to bunch of
5:47
diseases and issues without respecting
5:50
him as a whole you know what matters to
5:53
him what is his background what sort of
5:57
goals he's trying to achieve what are
5:59
the challenges that he's experiencing
6:01
etc
6:03
etc and in most extreme cases this gets
6:06
into the theory of shatter window so the
6:08
theory of shatter window describes a
6:10
situation where Specialists Focus only
6:13
on their area of expertise creating a
6:16
fracture approach that fails to address
6:18
the whole person need so imagine a
6:20
patient with multiple severe illnesses
6:23
like enderage renal disease on dialysis
6:27
moderate to severe cognitive impairment
6:30
severe heart failure and is now
6:32
diagnosed with cancer and the medical
6:35
oncologist might be embarking on
6:37
administering chemotherapy to this
6:40
patient this patient may have had no
6:42
functional activity and have been
6:44
dependent on others for almost all of
6:48
his daily activities and at the same
6:50
time he may have experienced some
6:52
exhausted support system because of
6:55
increasing needs that he has had
7:00
so this I call it ever growing
7:02
multi-dimensional problem of the Aging
7:04
population so this is not just Mr P by
7:08
2050 the number of people age 65 and
7:12
older is projected to become more than
7:14
double reaching 1.6 billion globally in
7:18
the United States adults over 65 will
7:21
represent nearly 22% of the population
7:24
by 2040 this demographic shift increases
7:28
demands for chronic disease management
7:30
and specialized geriatric care while
7:33
creating Workforce shortages in
7:34
geriatric medicine also these patients
7:37
because of advances in other disciplines
7:40
which is a great news however that leads
7:42
to long-term care needs such as more
7:45
medical attention and long-term care
7:47
facilities Etc and on the social and
7:51
economic side that creates some
7:53
Financial strain on the system and calls
7:56
for the need for age-friendly Community
7:58
planning and housing options this leads
8:01
us to what I call it the new age
8:03
Challenge and that is not all older
8:05
adults are at the same level of Fitness
8:07
the Aging population represents a
8:09
diverse spectrum of physical and
8:11
cognitive capabilities that cannot be
8:14
approached with one- siiz fital approach
8:16
this diversity requires a personal
8:18
approach to geriatric care recognizing
8:21
that chronological age often poorly
8:23
predicts an individual functional
8:25
abilities health status or care
8:27
needs I'm pretty sure have seen two 80y
8:31
olds who have had different level of
8:33
Fitness one is a marathon runner the
8:36
other one is unfortunately is not doing
8:38
very well and at times it's not just
8:40
about two 80 year olds one 80y old and
8:44
the other one is 75y old might have a
8:46
different level of Fitness that
8:48
80-year-old might be more fit than the
8:50
75y old and so on these people also may
8:55
experience different level of cognitive
8:57
function one might be very robust and
8:59
sharp while the other unfortunately may
9:01
have experienced some cognitive decline
9:04
even in the earlier and younger ages and
9:07
also these patients might differ in
9:09
terms of their medical complexity one
9:11
patient may experience one or two
9:14
comorbidities such as high blood
9:16
pressure or high cholesterol but then
9:18
the other one may experience 10 12
9:21
comorbidities and some of them very
9:23
severe like dialysis severe cognitive
9:26
impairment multiple Falls hip fracture
9:29
and so on so the new AG challenge
9:32
pressures Healthcare Providers to
9:34
develop individualized assessment tools
9:36
and treatment plans that address the
9:38
specific needs preference and
9:40
capabilities and capacities of each
9:42
older
9:43
adult this becomes somewhat more
9:46
problematic when patients are admitted
9:48
to the hospital and that is most of the
9:50
time medical assessment for older
9:52
patients begin with a generic phrases
9:55
like 82-year-old male without describing
9:58
the whole person
10:00
healthare rate records reduce older
10:02
adults to age gender and chief complaint
10:05
failing to capture their overall health
10:07
status functional capacity and personal
10:09
preferences as we discussed two 82y old
10:13
men might have completely different
10:15
capabilities one living independently
10:17
and being physically active and the
10:19
other one being frail with some
10:21
cognitive decline requiring significant
10:23
assistance this reduction approach
10:26
especially during Hospital stay leads to
10:28
inappropriate care plans and missed
10:30
intervention
10:33
opportunities so many of us are
10:37
interested in predicting outcomes from a
10:40
patient and caregiver point of view that
10:42
usually comes with questions like what
10:44
are my
10:45
prognosis what is my ability to go back
10:48
home and remain independent I don't want
10:51
to be a burden on my family what is the
10:54
likelihood of that thing happening
10:56
Etc and in reality a negative outcome is
10:59
a product of Frailty and stressors so we
11:03
are going to talk a lot more about
11:04
Frailty but a stressors could be reason
11:07
for admission and its severity
11:09
procedures tests and treatments that you
11:11
are scheduled to go for comorbidities
11:14
and their severity that you're
11:16
experiencing and other environmental
11:18
stressors such as availability of the
11:21
caregiver availability to accessing
11:23
various resources in the community the
11:26
financial strain that you may be
11:28
experiencing and so on
11:30
so when frail is combined with multiple
11:32
stressors the risk of adverse clinical
11:34
outcomes increases
11:37
proportionally so what can substitute
11:39
age I'm pretty sure many of you have
11:42
wondered why this doctor is treating me
11:45
or not treating me simply based on my
11:47
age or why that doctor gave me that
11:49
treatment I couldn't tolerate it why he
11:52
gave it to me despite my older age in
11:55
reality in geriatrics we are not very
11:57
interested in age of the patient but we
11:59
are interested on whether you're frail
12:02
or fit so what is frailty Frailty is
12:05
your body's decreased or complete
12:07
inability to tolerate a stress which
12:10
represent a state of increased
12:11
vulnerability to adverse outcomes when
12:13
exposed to a stressors so let's talk
12:16
about this more so these are three
12:18
patients one is managing well or
12:20
considered to be fit and the other one
12:22
has mild Frailty and the other one has
12:23
severe Frailty let's say these three
12:26
patients are all age 82 two and they are
12:30
all going for resection of the part of
12:32
their large intestine because they are
12:34
diagnosed with colon cancer the one that
12:37
is managing well or also known as fit
12:40
that per person under goes that surgery
12:43
stays in the hospital for a few days uh
12:45
recovers very quickly goes home and
12:47
probably is not going to be readmitted
12:49
to the hospital at all on the other hand
12:52
a patient with severe falty who under
12:54
goes the same surgery may stay in the
12:56
hospital for weeks may end up with some
12:58
complication PA s may experience a
13:01
significant functional Decline and may
13:03
never recover to the Baseline that he
13:05
was so this is what Frailty
13:10
means many Studies have shown the
13:13
relationship between Frailty and outcome
13:15
so this is a study on close to 67,000
13:19
patients who underwent cardiac surgery
13:22
and as you see frail patients were two
13:24
times more likely to have mortality
13:26
during the time of surgery and three
13:28
time times more likely to have midterm
13:31
mortality they were at much higher risk
13:33
for prolonged Hospital stay and be
13:36
discharged to non-home settings such as
13:38
nursing home or rehab
13:41
facilities there's also a difference uh
13:44
in life trajectory of Fit versus frail
13:47
patients so fit older adults typically
13:49
maintain their functional Independence
13:51
for much longer period of time with a
13:53
shorter period of disability before that
13:55
and relatively steep terminal Decline
13:58
and the other hand frail older adults
14:00
often experience earlier functional
14:02
decline with prolonged periods of
14:04
disability more frequent hospitalization
14:07
and gradual downward
14:09
trajectory these distinct paths directly
14:12
impact quality of life and response to
14:14
Medical interventions highlighting why
14:17
personalized assessment Beyond
14:18
chronological age is
14:22
essential it's also important to note
14:25
that the relationship between Frailty
14:26
and health outcomes is a two-way streak
14:29
Frailty can lead to negative clinical
14:32
outcomes however negative clinical
14:34
outcome can also worsen Frailty creating
14:37
in the most extreme cases a vicious
14:39
cycle for example if a patient who is
14:42
frail is admitted to the hospital
14:44
because of that prolong Hospital stay
14:46
and bed rest during that hospital stay
14:48
may lose more muscle mass and be at risk
14:50
for additional Frailty fs and fractures
14:53
which can then worsen Frailty breaking
14:56
the cycle requires proactive Frailty
14:59
assessment targeted preventive
15:01
interventions and Specialized Care
15:03
approaches that addresses the unique
15:05
vulnerabilities of all frail older
15:09
adults it's also important to note the
15:12
relationship between Frailty and age
15:15
although as we age we are more likely to
15:18
experience Frailty but not all older
15:20
patients are frail as we discussed there
15:23
could be two 85 year olds one could be
15:26
very fit and the other one could be very
15:28
frail also not older adults or not
15:31
people of the same age are going to be
15:34
frail one study showed that only 25% of
15:37
adults over the age of 85 is considered
15:39
to be frail while 75% of them maintain
15:42
varying degree of
15:44
robustness again understanding this
15:46
complex relationship enables Healthcare
15:49
Providers to move Beyond age-based
15:51
assumptions and develop more
15:53
personalized care
15:56
approaches so the golden standard of a
15:58
assessing Frailty is comprehensive
16:00
geriatric assessment a multi-dimensional
16:02
interdisciplinary diagnostic process to
16:05
determine an older person's medical
16:07
psychological and functional
16:09
capabilities components of geriatric
16:12
assessment include evaluation of
16:13
physical health cognitive function
16:15
psychological State functional abilities
16:18
like activities of daily living like
16:20
bathing and grooming instrumental
16:22
activities of daily living taking
16:24
medications handling finances
16:26
availability of social support
16:28
Environmental factors and nutritional
16:30
status this assessment provides a more
16:33
accurate prediction of outcomes than
16:35
chronological age alone helping
16:38
clinicians develop personalized care
16:39
plans that address a specific
16:41
vulnerabilities and
16:43
strengths this is conducted by
16:45
interdisciplinary team which includes
16:47
geriatricians nurses social workers
16:49
physical therapists pharmacist and other
16:51
Specialists as needed when implemented
16:54
systematically geriatric assessment has
16:56
been shown to reduce Hospital
16:57
readmissions decrease Healthcare cost
17:00
improve quality care and quality of life
17:04
and help maintain functional
17:05
Independence in all
17:09
adults there are various initiatives to
17:12
incorporate geriatric assessment and
17:13
management in different phases of care
17:16
we do have geriatric emergency
17:18
department these are specialized
17:19
emergency departments designed to meet
17:21
the unique needs of older adults
17:24
featuring enhanc staff training modify
17:27
physical environments and integrate ated
17:29
geriatric assessment protocols to
17:31
improve outcomes and reduce Hospital
17:34
admissions geriatric surgery
17:36
verification program which developed by
17:38
American College of Surgeons to
17:39
systematically improve surgical care for
17:41
older adults we do have geriatric
17:44
impatient units as well as outpatient
17:47
geriatric clinics which are dedicated to
17:49
provide comprehensive evaluation and
17:51
Care planning to support Community
17:53
dwelling order adults serving as a
17:55
coordination hubs for complex care needs
17:58
and preventive
18:00
interventions so in conclusion geriatric
18:03
care requires moving beyond
18:05
chronological age to truly understand
18:08
and address the complex needs of order
18:09
adults and throughout this presentation
18:12
we explored how traditional approaches
18:14
to Elderly Care often fall short as
18:16
illustrated by the case of Mr P we've
18:19
seen how chronological age alone is
18:22
inadequate predictor of Health outcomes
18:24
and clinical needs instead comprehensive
18:27
geriatric assessment and Frailty
18:28
measurement provide a more accurate
18:31
picture of an older adult's condition
18:34
the key takeaways from this
18:36
presentation include fry not age is a
18:41
better predictor of clinical outcomes
18:42
and should guide treatment decisions the
18:45
shattered window Theory highlights how
18:47
seemingly minor issues can Cascade into
18:49
major Health crisis for older adults and
18:53
unfortunately even at that time some
18:54
care providers still may miss the crisis
18:58
comprehensive Peri atric assessment
18:59
involving interdisciplinary team
19:01
significantly improve patient outcomes
19:04
and Specialized Care models such as
19:06
emergency department surgical programs
19:08
impatient and outpatient clinics and
19:10
units have demonstrated Effectiveness in
19:12
reducing complications and improving
19:14
quality of life the multi-dimensional
19:17
challenges of an aging population
19:19
require Innovative approaches that
19:21
address physical cognitive and social
19:23
aspects of Care by implementing these
19:26
evidence-based approaches across
19:27
Healthcare settings
19:29
we can transform care for older adults
19:31
improving their quality of life reduce
19:33
health care costs and better address the
19:37
complex needs of all our aging
19:39
population if you like this presentation
19:43
please like the video subscribe to the
19:46
channel and share it with your family
19:49
members and friends again this is Armen
19:52
Shuki I'm a geriatric oncologist very
19:55
dedicated to improving care for older
19:57
adults with or without can answer and I
19:59
hope you enjoy this lecture
#Aging & Geriatrics